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Research at the Liverpool School of Tropical Medicine (LSTM) has developed a successful approach to the rapid scale-up of HIV Testing and Counselling (HTC) services in high prevalence countries, a vital component of the global HIV response. The model combines comprehensive quality assurance with operational research and has led to HTC expansion in mobile, home and facility-based settings. It has also allowed for responsiveness to local needs leading to post rape care services linked to HTC, services for the deaf and HTC for men who have sex with men (MSM) and other hidden populations in Africa. The global impact of this model is reflected in WHO policy, Ministry of Health HTC guidelines in numerous countries in Africa, the on-going work of an indigenous Kenyan NGO and expansion of HTC through community outreach in the UK.
Since 2000, the tyrosine kinase inhibitor (TKI) imatinib has transformed CML from a fatal disease for half of patients within 5 years, to a chronic disease whereby ~ 90% of patients lead normal lives for at least 9 years. This remarkable transformation has spawned a second phase of clinical and translational research aiming to cure CML. The University of Liverpool (UoL) CML research group headed by Prof Richard Clark has been integral in both phases, particularly in the development of the second generation TKI nilotinib. Important contributions have also shed light on CML biology and the possible mechanism of acute leukaemic transformation (blast crisis).
Globally the most important cause of encephalitis (inflammation and swelling of the brain) is the mosquito-borne Japanese encephalitis virus (JEV), which causes an estimated 70,000 cases annually across Asia. Although vaccines were developed years ago, their uptake in Asian countries has been hampered through lack of disease burden data, a consequence of poor surveillance, complicated diagnostics, and insufficient knowledge about disease outcomes. Research at the University of Liverpool has addressed each of these areas in turn, to overcome the roadblocks in vaccine implementation. The University of Liverpool (UoL), through its leading role on all the relevant WHO committees groups and meetings, has ensured that its research findings are translated through to impact by supporting new vaccination programmes across Asia. By 2013 vaccination had begun in 11 new countries, and the vaccine had reached more than 200 million people. The public health benefits, estimated from a health economic modelling study, are 854,000 cases and 214,000 deaths avoided, with an associated saving across Asia of US$ 1.024 billion.
Scientists at the Liverpool School of Tropical Medicine (LSTM) have proven that targeting an essential bacterial symbiont, Wolbachia, with a course of antibiotics cures patients of their parasitic worms and improves disease pathology. This discovery in 1999 offers superior efficacy compared to existing anti-filarial drugs delivering prophylaxis, transmission blocking, safe macrofilaricidal activity and improved case management therapy. This approach has been endorsed by WHO elimination programmes for onchocerciasis, (Onchocerciasis Elimination Programme for the Americas, OEPA) and lymphatic filariasis (Global Programme to Eliminate Lymphatic Filariasis, GPELF). The Centre for Disease Control (CDC), also recommends this new strategy for elimination and morbidity management.
The University of Liverpool (UoL) has developed novel tamponade agents used to treat retinal detachments. They are modified silicone oils that have an increased extensional viscosity. This makes it easier to inject into the eye by the vitreoretinal surgeons and, experimentally, they have an increased emulsification resistance. This technology has been licenced to Fluoron GmbH who manufacture these products under the name Siluron® 2000 and Siluron® Xtra. Siluron® 2000 has been on the market worldwide since 2008 and used to treat patients providing an impact to health by enhancing the clinical outcome for retinal detachment patients. Siluron® Xtra was launched in July 2013.
Chronic lung infections due to Pseudomonas aeruginosa are the major cause of morbidity and mortality associated with cystic fibrosis. Some strains of P. aeruginosa transmit between patients (epidemic strains). The Winstanley group, at the University of Liverpool (UoL) since 1999, in collaboration with clinicians in Liverpool, has developed diagnostic PCR assays for identification of the most widely reported UK epidemic strains of P. aeruginosa. The NHS clinicians use these tests to make informed decisions about patient segregation leading to markedly reduced incidence of LES infections. Researchers internationally have adopted the UoL research results and strategy to tackle other transmissible strains and modify clinical procedures.
The University of Liverpool (UoL) research has had health impact on immune-mediated drug hypersensitivity reactions, which can be severe and life-threatening. It has shown that predisposition to hypersensitivity reactions caused by abacavir, nevirapine, carbamazepine and flucloxacillin is due to specific HLA genes on chromosome 6. This has led to changes in the drug label and guidelines for abacavir, increased HLA-B*57:01 gene testing in the NHS through a University spin-out company, and a reduction in the incidence of hypersensitivity from 7% to <1%. The more recent demonstration of HLA-A*31:01 and predisposition to carbamazepine hypersensitivity, has led to drug label changes for carbamazepine.
The University of Liverpool (UoL) research identified corticosteroid treatment for more than 3 consecutive months as a risk for serious sepsis in Crohn's disease and an indicator of poor practice; there are 115,000 Crohn's disease patients in the UK. Following this, national audits of Inflammatory Bowel Disease (IBD), also under UoL leadership, showed reduction in inappropriate long term steroid from 46% of Crohn's disease patients in 2006 to 21% in 2010. These audits led to widespread adoption of National Service Standards for the Care of Patients with IBD. Death and hospital readmission rates for IBD patients were subsequently significantly reduced.
University of Liverpool (UoL) research has characterised patients with pancreatitis at high risk of pancreatic cancer, defining strategies for their management now widespread globally. Clinical and genetic characterisation was conducted through the European Registry of Hereditary Pancreatitis and Familial Pancreas Cancer (EUROPAC), set up by the UoL in 1997 to pioneer secondary screening and trial appropriate management. As a result, it is now widely recommended that patients with a family history of pancreatitis should undergo genotyping and secondary screening, because of their risk of pancreatic cancer.
Meningococcal disease (MCD) is a major cause of morbidity and mortality worldwide. Underpinning research by Dr Carrol and colleagues at the University of Liverpool (1997-1999), has led to improved diagnosis and case confirmation, establishing Polymerase Chain Reaction (PCR) of meningococcal DNA as a gold standard test for diagnosis. The result is better management and therefore, impact on health and welfare of patients, and on practitioners. The work was conducted in collaboration with the Meningococcal Reference Unit, which provides a national diagnosis and surveillance service. The test was recommended in NICE guidelines in 2010, thereby impacting public policy.